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What is syphilis?
Syphilis is a complex sexually transmitted disease (STD)
caused by the bacterium Treponema pallidum. It has often
been called "the great imitator" because so many of the
signs and symptoms are indistinguishable from those of
other diseases.
How is syphilis spread?
Syphilis is passed from person to person through direct
contact with a syphilis sore. Sores occur mainly on the
external genitals, vagina, anus, or in the rectum. Sores
also can occur on the lips and in the mouth.
Transmission of the organism occurs during vaginal,
anal, or oral sex. Pregnant women with the disease can
pass it to the babies they are carrying. Syphilis cannot
be spread by toilet seats, door knobs, swimming pools,
hot tubs, bath tubs, shared clothing, or eating
utensils.
What are the signs and symptoms in adults?
Primary Stage
The time between infection with syphilis and the
start of the first symptom can range from 10-90 days
(average 21 days). The primary stage of syphilis is
usually marked by the appearance of a single sore
(called a chancre), but there may be multiple sores. The
chancre is usually firm, round, small, and painless. It
appears at the spot where syphilis entered the body. The
chancre lasts 3-6 weeks, and it will heal on its own. If
adequate treatment is not administered, the infection
progresses to the secondary stage.
Secondary Stage
The second stage starts when one or more areas of
the skin break into a rash that usually does not itch.
Rashes can appear as the chancre is fading or can be
delayed for weeks. The rash often appears as rough, red
or reddish brown spots both on the palms of the hands
and on the bottoms of the feet. The rash also may also
appear on other parts of the body with different
characteristics, some of which resemble other diseases.
Sometimes the rashes are so faint that they are not
noticed. Even without treatment, rashes clear up on
their own. In addition to rashes, second-stage symptoms
can include fever, swollen lymph glands, sore throat,
patchy hair loss, headaches, weight loss, muscle aches,
and tiredness. A person can easily pass the disease to
sex partners when primary or secondary stage signs or
symptoms are present.
Late Syphilis
The latent (hidden) stage of syphilis begins when
the secondary symptoms disappear. Without treatment, the
infected person still has syphilis even though there are
no signs or symptoms. It remains in the body, and it may
begin to damage the internal organs, including the
brain, nerves, eyes, heart, blood vessels, liver, bones,
and joints. This internal damage may show up many years
later in the late or tertiary stage of syphilis. Late
stage signs and symptoms include not being able to
coordinate muscle movements, paralysis, numbness,
gradual blindness and dementia. This damage may be
serious enough to cause death.
Can a newborn get syphilis?
Depending on how long a pregnant woman has been
infected, she has a good chance of having a stillbirth
(syphilitic stillbirth) or of giving birth to a baby who
dies shortly after birth. If not treated immediately, an
infected baby may be born without symptoms but could
develop them within a few weeks. These signs and
symptoms can be very serious. Untreated babies may
become developmentally delayed, have seizures, or die.
How is syphilis diagnosed?
A health care provider can diagnose syphilis by using
dark field microscopy to examine material from
infectious sores. If syphilis bacteria are present in
the sore, they will show up with a characteristic
appearance.
A blood test is another way to determine whether someone
has syphilis. Shortly after infection occurs, the body
produces syphilis antibodies that can be detected by an
accurate, safe and inexpensive blood test. A low level
of antibodies will stay in the blood for months or years
even after the disease has been successfully treated.
Because untreated syphilis in a pregnant woman can
infect and possibly kill her developing baby, every
pregnant woman should have a blood test for syphilis.
How common is syphilis?
In the United States, over 35,600 cases of syphilis were
reported by health officials in 1999, including 6,650
cases of primary and secondary syphilis (a decline of
5.4% from 1998) and 556 cases of congenital syphilis in
newborns. More cases occur each year than come to the
attention of health officials. Of the nine states with
the highest 1999 syphilis rates (2-5 times higher than
the national rate of 2.5 cases per 100,000), eight were
in the South. Although syphilis rates remain higher in
the South than in other regions, the South had a 32%
decline in the primary and secondary syphilis rate from
1997 to 1999, illustrating that the greatest
improvements in disease control have taken place where
syphilis incidence has been the greatest. In 1999, 25
counties accounted for 50% of all primary and secondary
syphilis cases. Two hundred sixty-five counties had
syphilis rates above the U.S. Public Health Service's
Healthy People 2000 objective of 4 cases per 100,000.
These 265 counties (9% of the total number of counties
in the U.S.) accounted for approximately 74% of the
total primary and secondary syphilis cases reported in
1999.
In 1999, syphilis occurred primarily in persons aged 20
to 39, and the reported rate in men was 1.5 times
greater than the rate in women. The incidence of
syphilis was highest in women aged 20 to 29 years and in
men 30 to 39. Some fundamental societal problems, such
as poverty, inadequate access to health care, and lack
of education are associated with disproportionately high
levels of syphilis in certain populations. Cases of
primary and secondary syphilis in 1999 had the following
race or ethnicity distribution: African Americans 75%,
whites 16%, Hispanics 8%, and others 1%. Syphilis
reflects one of the most glaring examples of racial
disparity in health status, with the rate for African
Americans nearly 30 times the rate for whites.
What is the link between syphilis and HIV?
While the health problems caused by syphilis in adults
and newborns are serious in their own right, it is now
known that the genital sores caused by syphilis in
adults also make it easier to transmit and acquire HIV
infection sexually. There is a 2- to 5-fold increased
risk of acquiring HIV infection when syphilis is
present.
Is there a cure for syphilis?
Yes! A single dose of penicillin, an antibiotic, will
cure a person who has had syphilis for less than a year.
Larger doses are needed to cure someone who has had it
for longer than a year. For people who are allergic to
penicillin, other antibiotics are available to treat
syphilis. There are no home remedies or over-the-counter
drugs that will cure syphilis. Penicillin treatment will
kill the syphilis bacterium and prevent further damage,
but it will not repair any damage already done. Persons
who receive syphilis treatment must abstain from sexual
contact with new partners until the syphilis sores are
completely healed. Persons with syphilis must notify
their sex partners so that they also can be tested, and,
if necessary, receive treatment.
Will syphilis recur?
Having had syphilis does not protect a person from
getting it again. Antibodies are produced as a person
reacts to the disease, and, after treatment, these
antibodies may offer partial protection from getting
infected again, if exposed right away. Even though there
may be a short period of protection, the antibody levels
naturally decrease in the blood, and people become
susceptible to syphilis infection again if they are
sexually exposed to syphilis sores.
How can people protect themselves against infection?
Two people who know that they are not infected and who
have sex only with each other cannot contract syphilis.
When someone's syphilis status is unknown, a good
defense against becoming infected during sex is to use a
latex condom before beginning sex and to keep it on
until the penis is withdrawn. However, condoms do not
provide complete protection because syphilis sores can
sometimes be on areas not covered by a condom. This is
equally important for other STDs, including HIV, as
well. Only lab tests can confirm whether someone has
syphilis. Because syphilis sores can be hidden in the
vagina, rectum, or mouth, it may not be obvious that a
sex partner has syphilis. Washing the genitals,
urinating, or douching after sex does not prevent STDs,
including syphilis. Any unusual discharge, sore, or
rash, especially in the groin area, should be a signal
to stop having sex and to see a doctor at once.
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